Timely initiation of breastfeeding: How influential are hospital's routines?

INTRODUCTION:  Breastfeeding in known to be beneficial to both, mothers and infants. Although timely initiation of breastfeeding is considered a crucial action to reduce child morbidity and mortality, its prevalence is still low, specially in countries that present high rates of c-sections, such as Brazil.

METHODS:  This paper aims to determine prevalence and factors associated to timely initiation of breastfeeding in a sample of 1257 women from Queimados and Petrópolis, Rio de Janeiro State, Brazil. It is a hybrid study defined as prevalence follow-up, which has a cross-sectional outcome and explanatory variables collected on a cohort manner. Data on sociodemographic, maternal health and obstetric, prenatal care, hospital routines and childbirth conditions was collected through two-moment interviews occurring during pregnancy and childbirth hospitalization. Outcome was reported by mothers as breastfeeding initiation within the first 60 minutes after birth. Bivariate analysis were carried out using t-student and chi-square tests, every variable reaching significance level of 0.20 or lower and not presenting correlation coefficients higher than 0.80 was inserted on an hierarchic Poisson regression with robust variance for multivariate analysis.  Final analyses were performed with a significance level of 5%.

RESULTS: Prevalence of timely initiation of breastfeeding was 52.3% (CI 95% 50-55). Higher maternal education (PR 0.84, CI95% 0.75-0.94), receiving prenatal care in more than one establishment (PR 0.80, CI95% 0.70-0.92), preterm baby (PR 0.67, CI95% 0.53-0.86), and c-section delivery (PR 0.56, CI95% 0.49-0.65) were inversely associated to the outcome, while inadequate prenatal care (RP 1.14, CI95% 1.01-1.30), early skin-to-skin contact (PR 1.13, CI95% 1.02-1.25) and being placed in rooming-in care (PR 2.22, CI95% 1.59-3.12) were positively associated to breastfeeding within the first hour of life. 

CONCLUSIONS: Hospital routines act directly and indirectly on the determination of timely initiation of breastfeeding and therefore should be the main focus of educative and regulatory health actions.